Healthcare Provider Details

I. General information

NPI: 1871274753
Provider Name (Legal Business Name): KELSEY NOGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax:
Mailing address:
  • Phone: 303-436-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY.0006925
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0006925
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0006925
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: